One of my patients, Ann, asked me the other day about agave syrup. "Is it a better choice than regular sugar?" I had to tell her I really didn't know the answer to that. But I vowed to find out. Agave syrup is a sugar substitute that started to become very popular about three years ago. It is very sweet and has a good taste to it. But there are some surprising things you need to know about agave before you run right out and start putting much of it into your diet.

A recent study analyzed 19 pure agave syrups representing the three major production regions and four processing facilities in Mexico. What they found in several of these "pure" agave syrups was that they had been diluted out with high fructose corn syrup, dextrose, and/or sucrose (table sugar). Typically agave is made of 90% fructose. Fructose is the sugar found primarily in fruits. But because they had been diluted out, some of the agave syrups they tested had much lower fructose levels. So the truth is that unless you know better, there doesn't seem to be a way of knowing for sure if the agave syrup you are eating is in fact agave syrup. But even if you are getting the real thing, there may still be a problem.

The researchers decided to see what would happen if they sweetened the drinking water of some rats with the real thing, pure agave. They also sweetened the water of other rats with either regular sugar or high fructose corn syrup. The level of sweetness was less than that of the soda and sports drinks that so many Americans like. But the idea was to see what happened to the rats when all their drinking water contained the high levels of fructose found in agave. Here's what they found.

The sweet water caused the rats to drink more water than usual. Apparently rats like sweets as much as we do. And the higher the levels of fructose in the water, the more they drank. When they looked to see the effect on the liver of all this fructose they found "modest but significant changes in markers of liver and lipid metabolism." They concluded that the data showed that "even moderate fructose consumption might contribute to the onset or development of the metabolic syndrome."

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So right off the bat you can see that there certainly is nothing nutritionally beneficial about agave and all the fructose it contains. If you take enough of it, you will want more and will start to see harmful changes to your liver. These are changes that can go on to cause metabolic syndrome and possibly diabetes. This is ironic because unlike regular sugar, fructose does not raise blood sugar levels and does not stimulate insulin resistance. But because of its damaging effect on the liver, in no way can you call it a "healthy sugar." But having said that, I don't see why you can't go out and have some agave in your coffee or tea. Here's why.

I have preached over and over for years that no substances are inherently safe and no substances are inherently toxic. As Paracelsus said 400 years ago, "The poison is in the dose." There is a safe dose for everything including mercury and a toxic dose of everything including vitamin C. And this is the key to deciding if you want some agave in your coffee. The only water these rats got had agave. That would be similar to you drinking nothing but fluids that contained agave. Everything you drank would need to add agave syrup. But who does that? Actually, a lot of people — especially kids.

They don't drink fluids with agave per se. But many of them live off sodas and sports drinks that contain high levels of fructose in the form of high fructose corn syrup and sucrose. And according to general consensus that is the main reason why we have such an epidemic of childhood obesity and adult diabetes.

So if you want to add some agave to your drinks every now and then, go ahead. It will keep your blood sugar low and a small amount is not going to hurt you. But just do it every now and then. Agave has twice the amount of fructose in it that regular sugar and high fructose corn syrup have. So it is going to have twice the damage potential to your liver. How can you tell if you are taking too much? Just check your triglyceride blood levels. Fructose raises triglyceride levels. A healthy level is below 100.

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